The importance of shifting clinical considerations to the utilization of intravenous thrombolytics in acute ischemic stroke patients with unruptured intracranial aneurysms has gained prominence. Accordingly, complicated treatment decisions after thrombolytic therapy associated with the risk of hemorrhagic transformation that results from an intracranial aneurysm necessitated the careful evaluation in balancing the potential benefits of reperfusion with the increased risk of rupture. 

In pursuit of scientific enlightenment, our research spanned the expanse of esteemed databases, including PubMed/MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov, up to the latest available data in August 2023.

For the studies included in our analysis, a meticulous narrative synthesis was executed to succinctly epitomize crucial details, encompassing study characteristics, participant demographics, intervention particulars, and primary outcomes. Furthermore, a quantitative meta-analysis was performed, employing appropriate statistical methodologies, selected in accordance with the observed degree of heterogeneity among the studies.

In our systematic review, encompassing a total of 50 studies, with 14 of them being case reports, involving a total of  15,000 patients, we delved into the realm of intracranial aneurysms within acute ischemic stroke patients treated with intravenous thrombolysis.

Our findings bring forth a noteworthy revelation that the incidence of incidental unruptured intracranial aneurysms detection among AIS patients subjected to intravenous thrombolysis is notably low. Notably, Our analysis demonstrated minimal heterogeneity among the studies, and the results yielded statistical significance (95% CI 1-7%, I2=0.00%, p=0.90).

In the management of acute ischemic stroke patients with unruptured intracranial aneurysm, the utilization of intravenous thrombolytics exhibits a multifaceted clinical context. Skillfully balancing the benefits of prompt reperfusion with the latent risk of aneurysmal rupture. The imperative lies in an individualized assessment, meticulously considering aneurysm dimensions, precise anatomical location, and patient-specific variables.